Management of duane retraction syndrome

Background Duane retraction syndrome (DRS) is a congenital ocular motility disorder most commonly characterized by the inability of the eye to abduct, sometimes limitation of adduction, and globe retraction with palpebral fissure narrowing on adduction. Aim To study the clinical features, management, and outcome of DRS. Patients and methods A prospective, nonrandomized study was carried out on patients attending the Outpatient Clinic of Ophthalmology in Menoufia University Hospital during the period of study from June 2017 to July 2019. This study was conducted on 51 patients with DRS. Ocular and systemic features were studied. Surgery was done when indicated to eliminate upshoot or downshoot, face turn with a horizontal deviation, and globe retraction. Preoperative and postoperative ocular deviation, angle of head turn, and severity of limitation in abduction and adduction were detected and analyzed. Results Type I DRS was more common (70.6%), with female preponderance (52.9%) and a predilection for the left eye (70.6%). Twenty-one (41.2%) cases were operated, by recessing MR and/or lateral rectus (LR) muscles and/or Y-splitting and acceptable improvement was detected. Mean esotropic DRS improved from 18 +/- 4.02 to 3 +/- 2.8 (P<0.001) and mean exotropic DRS improved from 14 +/- 2 to 5 +/- 1.4 (P<0.01). Upshooting/downshooting and narrowing of the palpebral fissure showed significant improvement (P<0.001 and <0.03, respectively). Conclusion Proper diagnosis of patients with DRS and proper plan for surgical management can reduce several complications with satisfactory postoperative outcomes.